Policy Memo: Illinois Medicaid Redetermination Project

Summary:

The Illinois Save Medicaid Access and Resources Together (SMART) Act (PA 97-0689) requires the state to use electronic data verification to aid in the timely redetermination of medical eligibility. The law also requires that Healthcare and Family Services (HFS) contract with an external vendor to enhance the integrity of redeterminations of medical eligibility.

Effective 01/02/13, the Illinois Medicaid Redetermination Project (IMRP) establishes new procedures for the external vendor and the HFS All Kids and Department of Human Services (DHS) Family Community Resource Center (FCRC) staff to assure accurate and timely completion of medical redeterminations.

HFS has contracted with Maximus to serve as the external vendor under IMRP. Maximus has subcontracted with Health Management Systems (HMS). Maximus and HMS provide the electronic cross-match information and operate the IntegriMatch System used for IMRP.

Only state caseworkers redetermine medical eligibility. However, based on the verifications it obtains, Maximus makes recommendations concerning whether a customer continues to be eligible for medical benefits.

Maximus posts information to the IntegriMatch System for use by state caseworkers in conducting redeterminations. This information includes verified data on customer's income, resources, Illinois residency and, if previously unverified, citizenship or immigration status with a recommendation concerning eligibility.

Maximus also posts images of documents it obtained to the IntegriMatch System where they are viewable by caseworkers. At a later date, imaged documents will also be loaded into Content Manager for use by caseworkers.

Caseworkers use the information posted by Maximus and other information available to them to redetermine on-going eligibility for medical assistance.

Until further notice, caseworkers must run ACID using SSN and name file clearances for all persons in the case before approving a medical-only case for continued eligibility. Take appropriate action if duplicate coverage is found.

Maximus contacts medical-only customers if the cross-matched data is insufficient to make a recommendation of continued eligibility. Maximus will use only state-approved notices and guidelines when contacting customers.

Maximus contacts medical-only customers if the cross-matched data is insufficient to make a recommendation of continued eligibility. Maximus will use only state-approved notices and guidelines when contacting customers.

Starting in April, 2013, SNAP/medical and cash cases will select for the IntegiMatch the month prior to the month the REDE is due. Maximus will post the electronic information to IntegriMatch for DHS caseworkers to use when processing REDEs.

For medical with SNAP or cash cases, Maximus will enter a recommendation concerning medical eligibility if a high probability that the case is no longer eligible is found through the initial cross-matches.

Maximus does not contact customers who receive cash, SNAP or QMB/SLIB/Q-1 only benefits.

Under the law, DHS/HFS staff must complete a redetermination and post the final results of their work to the IntegriMatch worker portal within 20 business days of the date Maximus entered the recommendation.

All cases, including those for whom eligibility continues unchanged, will now receive a notice upon completion of the redetermination.

Beginning December 2012, most centrally generated medical redetermination notices are no longer mailed to the customer by the state; Maximus will notify customers as necessary.